Abstract
Cognitive dysfunction is often multifaceted and can be seen across all age groups in medicine. The combination of cognitive decline and increased intracranial pressure may suggest possible anatomical abnormalities. We present a case report from our academic center that describes a young man with new cognitive fatigue and brain fog in the setting of increased venous pressure that resolved with surgical intervention at a site of jugular vein stenosis. We discuss current hypotheses from basic and clinical research related to pathophysiology underlying venous vascular congestion and associated neurologic disorders. Further research is warranted to elucidate the underlying mechanisms of venous congestion and cognition to better identify therapies and improve quality of life for patients.
Pearls
Dynamic venography performed with provocative neck maneuvers and measurement of torcular pressure will identify at-risk patients with suspected cerebral venous congestion.
An elevated cerebral venous pressure gradient by the transverse process of C1 can be reduced by C1 tuberculectomy.
Oy-sters
In patients presenting with suspected abnormal intracranial pressure and new cognitive decline, the possibility of cerebral venous congestion (CVC) from stenosis or obstruction should be considered.
Cognitive decline is often irreversible in several neurologic conditions; however, symptoms secondary to CVC can be reversed when promptly intervened.
Case Report
A 30-year-old man without prior medical diagnosis presented to the emergency department with a new, persistent headache. He described the headache as a pressure-like sensation, worse while standing, associated with gait imbalance, and resolving when supine without moving his head. Over-the-counter medications provided minimal relief of symptoms. One month before his presentation, he suffered a ground-level fall from his mountain bike, resulting in minor head trauma without loss of consciousness. He was wearing a helmet during the fall. Three days before his presentation, he developed a new, persistent headache while riding his bike. He denied a history of headaches, blurry vision, or weakness. A review of systems was positive for back and neck pain. His neurologic examination was unremarkable, and he was referred to neurology for the evaluation of postconcussive headache.